Treatment-resistant hypertension (HTN) has been defined in various ways in clinical research. Some definitions go so far as to say which medications should be used before classifying patients as having resistant HTN. Regardless of the definition, the overriding theme of treatment-resistant HTN is that it occurs when several anti-hypertensive drugs are needed to control blood pressure (BP). Studies suggest that treatment-resistant HTN is present in 20% to 30% of patients with HTN. Its prevalence has more than doubled over the past 25 years, and research has linked it to an increased risk of cardiovascular events when compared with patients without treatment-resistant HTN. “The topic of treatment-resistant HTN has gained attention in recent years,” says Rhonda M. Cooper-DeHoff, PharmD, MS, FAHA, FACC. “The condition increases long-term risk for poor outcomes, regardless of whether or not HTN is controlled or uncontrolled. Unfortunately, we’re lacking important data on the long-term effects of treatment-resistant HTN.” Coronary artery disease (CAD) is among the leading causes of mortality, and treatment-resistant HTN is more common in patients with CAD than without CAD. Little is known, however, about the impact that treatment-resistant HTN has on cardiovascular outcomes in patients with CAD. Such data may inform clinicians on strategies to aggressively manage risk factors. Identifying Predictors & Impact In the Journal of Hypertension, Dr. Cooper-DeHoff and colleagues published a study that described the prevalence, predictors, and impact on adverse cardiovascular outcomes of resistant HTN among patients with CAD and HTN. More than 17,000 study participants were divided into three groups according to achieved BP: 1) controlled (BP<140/90 mm Hg on three or fewer drugs); 2) uncontrolled (BP≥140/90 mm Hg on...

Over time, the frequency of myocardial infarction (MI) in the United States has been declining overall as improvements have been made with regard to medical therapy for coronary artery disease. Although there has been a decline in the rate of ST-elevation MI (STEMI) in those aged 55 and older, the rate has remained steady in patients younger than 55 and among younger women. “Studies have shown that it’s harder to recognize the signs of MI in women,” says Luke Kim, MD, FACC, FSCAI. “Previous analyses indicate that women tend to receive less aggressive treatment than men.” Analyzing Disparities In a study presented at the Society for Cardiovascular Angiography and Interventions 2014 Scientific Sessions, Dr. Kim and colleagues analyzed data on about 13,000 women and more than 42,000 men aged 55 and younger who were hospitalized with an acute MI from 2007 to 2011 using the Nationwide Inpatient Sample database. The authors looked at temporal trends in MI as well as adverse in-hospital outcomes to compare findings by gender. The researchers observed a slight decline in the number of MIs among younger women between 2007 and 2009 but little change after that. Women had more preexisting health problems than men, including diabetes, hypertension, kidney disease, peripheral vascular disease, congestive heart failure, and obesity. Women were also more likely than men to have non-STEMIs. The study by Dr. Kim and colleagues also revealed that there were disparities in the treatment of MI. “Women who suffered an MI were far less likely than men to be treated with PCI or CABG surgery,” explains Dr. Kim. “They were also more likely to face...

Everyone knows there’s a shortage of primary care physicians, especially in rural areas. The state of Missouri has decided to alleviate this problem with a bill, signed into law by the governor this month, authorizing medical school graduates who have not done any residency training to act as “assistant physicians.” The assistant physicians will come from the pool of 7000 to 8000 graduates, mostly of offshore medical schools, who were unable to match to any residency. After spending 30 days with a “physician collaborator,” assistant physicians would be allowed to practice independently as long as they were within 50 miles of their collaborator. The physician collaborator is also required to review 10% of the assistant physician’s charts. Assistant physicians would be expected to treat simple problems and could prescribe Schedule III [including hydroxycodone or codeine when compounded with an NSAID as well as synthetic tetrahydrocannabinol], IV, and V drugs. Opponents of the bill included the American Medical Association, the Accreditation Council for Graduate Medical Education, and the American Academy of Physician Assistants. According to healthleadersmedia.com, the Missouri State Medical Association supported the bill. Its government relations director and general counsel, Jeffrey Howell, said the new rules would be no different than those for older doctors. “A lot of those guys didn’t have to go through a residency program. They just graduated from medical school and went back to the farming communities they grew up in, hung out their shingles, and treated people.” Perhaps Mr. Howell hasn’t heard that medicine is a bit more complex than it was 50 or 60 years ago. Proponents of the bill felt that rural...